MEDICARE: G & G MEDICAL GROUP INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME96322	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	56280	OTHER	FL	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1881751964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G & G MEDICAL GROUP INC.

Provider Business Mailing Address
First Line	:	1132 CYPRESS GLEN CIR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-7559
Country	:	US
Telephone Number	:	407-343-4700
Fax Number	:	407-343-8500

Provider Business Practice Location Address
First Line	:	1132 CYPRESS GLEN CIR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-7559
Country	:	US
Telephone Number	:	407-343-4700
Fax Number	:	407-343-8500

Authorized Official
Title or Position	:	MEDICAL PRACTICE ADMINISTRATOR
Name	:	MRS. LUANA ELIZABETH GONZALEZ
Credential	:
Telephone Number	:	407-343-4700

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	05/05/2016

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